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 Doctors without orders More medical students, poorer results June 27, 2002 The Iranian Iran's history of medicine is indeed fascinating. From the famous Avicena, the physician who diagnosed heart rhythm abnormalities by feeling the pulse, to Razi the inventor of alcohol, Iranian medicine has made a mark through history. In the mid sixties and seventies, Iranian universities such as Pahlavi University in Shiraz, were becoming an internationally respected. Eager medical students came from across the globe including Africa, and India to study in this prestigious institution. University of Pennsylvania's school of medicine, the first medical school in the U.S. founded by Benjamin Franklin, had established an exchange program with Pahlavi University. After the revolution Iran's medical establishment took a turn for the worse. During the early years after the revolution, physician shortagesbecame a major public health problem. This was mostly due the closure of universities and the mass exodus of some of Iran's top physicians to Western countries. As a result, the Iranian government decided to combat the problem by expanding medical schools. The uncontrolled increase in the enrolment process soon created two problems. 1) An over production of physicians. 2) A decrease in quality of teaching across medical schools. It is believed that 40,000 physicians are now unemployed. Even those who are lucky enough to find employment, the starting salary may be as low as 100,000 tomans per month, almost equal the salary of an unskilled civil servant. As a result, many leave their profession and earn a living doing odd jobs including tutoring for the konkoor, national university entrance exam. As the number of enrolment increases, the quality of teaching automatically drops, unless efforts are taken to compensate for this increase. The overcrowding of medical schools and the shortage of Western-trained physicians has dramatically reduced the quality of teaching. Many of Iran's young physicians are extremely bright as they have to score high on then national university entrance exam. However, they have to face overcrowded classrooms, shortage of faculty and residency positions. In the mid eighties Western medical schools started shifting away from a the traditional medical curriculum of didactic teaching to a more group oriented Problem Based Learning (PBL). First adapted by McMaster University in Canada and followed by Harvard University, PBL trains young medical students to be able to learn on their own and to critique the latest medical literature and apply the findings to their patients. Unfortunately, the shortage of resources has prevented this change to occur in medical schools in Iran. Unless some changes are made in the current medical curriculum to fix the current problems the number of unemployed physicians will continue to soar. Author Dr. Etminan is a pharmaceutical researcher at the University of Toronto. His recent findings on a new class of drugs that may prevent headache will be published in the June 2002 issue of the American Journal of Medicine.
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